I think I’ve got Vulvodynia or Vaginismus, what can I do?

Watch the video here.

Have you got Vulvodynia or Vaginismus?

Vaginismus is basically just tight pelvic floor muscles, which makes getting a tampon in or having penetrative sex painful or difficult. Your pelvic floor can be generally tight all the time (think about how tight your hamstrings get when you’ve been sat driving all day, the day after a run or you’ve never stretched them until that yoga class and down-dog was an experience..). Your pelvic floor muscles can also go into spasm when thinking about or having anything penetrate the vagina (like when your calf goes into cramp in the night). Both aren’t pleasant, and both are totally treatable. Treatment is exactly what you’d do with any other muscle – learn to relax them and give them a gentle (and regular) stretch. It shouldn’t hurt.

Vulvodynia is a pain in and on the vulva, where tests have shown there to be nothing ‘wrong’. I like to think of vulvodynia in these terms: your...

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Neurocentric approaches to treating pelvic pain with Dr Sandy Hilton

You can watch our chat here.

This is a Really exciting time in pelvic health where our understanding of the brain, pain and how we can change someone’s experience are all evolving. By this I don’t just mean in the psychological way, but in a true “pain experience” sense as well as thinking about how we can change biological markers and antecedents to pain, such as inflammation, with our words and how we approach people with chronic pain.

Sandy Hilton is a Doctor of Physical Therapy based in Chicago, America. She has contributed to multiple book chapters, papers, and co-authored “Why Pelvic Pain Hurts” and is an international instructor and speaker on treating pelvic pain for professionals and for public education. She’s also a regular contributor on health related podcasts, and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff, which I can wholly recommend as both a source of evidence and a great lesson in how...

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Talking pelvic pain treatment with Dr Jessica Reale

Lots of clinical pearls of wisdom! You can watch our conversation here.

I just had the pleasure of an EPIC chat with Dr Jessica Reale (Doctor of Physical Therapy) all about our clinical interpretation of the latest methods of treating pelvic pain. How and why do we do what we do? There’s some great examples and pearls of wisdom I’ve taken from this, as well as being a good benchmarking that we are all approaching it in a similar way. I’ve linked to all the apps and references for the papers mentioned below. You can find out more about her on her website by clicking HERE, along with a great blog of resources

It fills my soul with joy to connect with other physios interested in understanding and treating pelvic pain. To borrow her phrase, at this point in time it really does feel like we’re “pioneers” in this work. I’d put it less eloquently but the meaning is the same; we have pain and dysfunction based research not specific to the pelvis...

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Graded motor imagery and sensory integration for pelvic pain + IC/BPS

Graded motor imagery for pelvic pain + IC/BPS – should we be incorporating other senses? Watch the vlog here.

It’s time to be honest. Working in pelvic health can sometimes be lonely, in the UK we’re often in tiny clinics away from our teams. I’m certainly someone who thrives on discussing, debating and being challenged. So here are some of the things I’ve been doing with Graded Motor Imagery, how I’m approaching it at the moment and the realities of how it’s going – it takes time!

If you’ve got any comments, are using GMI or are passionate about treating or researching BPS I’d love to hear from you! Only from sharing our knowledge do we all improve. At the end of the day, that’s my mission – getting better at getting people better. Enjoy!

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Guest Blog: Endometriosis, hysterectomy and fistula

“For the first time in the majority of my adult life I wasn’t reliant on pain killers”

I’m really pleased to be able to bring you Jane’s story, in her own words. I’m incredibly proud of how far she’s come and how well she’s doing. It takes great emotional resilience to overcome the challenges she’ll tell you all about. If you’ve got Endometriosis or know someone who has, please share her story. Well timed Pelvic Health Physio can help people to avoid surgery by improving painful symptoms, and will always also support them through their complex surgical recovery to regain their lives.



Where to begin? Well, in the words of Julie Andrews, let’s start at the very beginning, a very good place to start.

I always had very heavy periods but I was told that periods hurt, it’s normal, just take some painkillers and just get on with it. Which I did. I didn’t really let it bother me, but as I grew...

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A quick guide to the what and why of Interstitial Cystitis / Bladder Pain Syndrome

What is Bladder Pain Syndrome?

The first thing to say about Bladder Pain Syndrome is what it’s Not….

Initially people went to their doctors with the symptoms of a chronic infection – a urinary tract infection or cystitis. They had an urgent need to pass urine, felt like they needed to go often and it would be accompanied by pain in the bladder region, perineum (between the legs) or in the urethra (tube from the bladder). However this went on much longer than an infection should, and often after taking antibiotics. The lining of the bladder is called the interstitium and so it was thought that when people presented with this group of symptoms they had a chronic infection of the bladder lining. This is how the name Interstitial Cystitis came around.

It’s now understood that Interstitial Cystitis/Bladder Pain Syndrome is much more complex, and many people do not have a chronic infection of the bladder or urethral lining. Even If they do have a chronic...

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Does a c-section increase your risk of bladder pain?

Watch the vlog here.

A few weeks ago I was given this paper by Gill Brook (thanks Gill!), and I think it’s another important step forwards in our knowledge about the aeteology of Bladder Pain Syndrome.

The full title of the paper is:
Will cesarean section increase the risk of interstitial cystitis/painful bladder syndrome?
Kun-Min Chang, Ming-Huei Lee, Hsuan-Hung Lin, Shang-Liang Wu, Huei-Ching Wu
Neurourology and Urodynamics. 2018;1–7.
DOI: 10.1002/nau.23704

Have a listen, I’d love to hear your thoughts! Catch me on Facebook or Twitter.

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Talking Graded Motor Imagery in Pelvic Pain with Katie Kelly

Watch the vlog here.

Katie and I got chatting online as we both have an interest in graded motor imagery in pelvic pain. Katie works on the East coast of Canada as a pelvic health physiotherapist and is researching graded motor imagery in women with pelvic pain with  Mount Allison Univeristy and Dalhousie University. She’s just completed a Phase 1 trial looking at how women with pelvic pain perceive images, and was kind enough to sit down and chat with me about her research and experience of what works for her in clinic.

It was really interesting to hear what kinds of images they’ve been using, the difficulties in finding images to represent motor and sensory activities for the pelvis, and what tools she uses in clinic.

Apologies for the sound quality, I’m working on it…

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Living with Endometriosis: Believe and Tri

I’m really glad to be able to bring you this fantastic, painfully honest blog by an inspiring Endometriosis survivor and triathlete. I was lucky enough to work with her on her journey back to sport and fitness following surgery. She never failed to inspire me with her grit, determination and gentle self-care. At the end of the day you can’t force your body into behaving a certain way, it has to be guided, cajoled and gently pursuaded. That can be frustrating, but she shows us how with gentle self-care and perserverence great things can be achieved. I’m really looking forward to reading more as her training progresses – you can HERE. And while you’re at it, if you have a few spare pennies please sponsor her Olympic Triathlon in June!


My journey has been a bit of odd one really.  I’ve had all the usual stuff of painful heavy awful periods in my teens but was on the pill from 16 which kept things sort of under control.  I was...

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Its not about the wand

Watch the Vlog: It’s not about the wand… it’s about all the other marvellous things you do to heal pelvic pain

I’ve had a lot of great conversations since I put up my wand vlog,  and I find that I’m coming back to the same areas so I decided that it’s time we talk about the wand.

1 . It’s a great tool but it’s not for everyone

In my clinic I do use them regularly with patients with difficulties reaching their pelvic floor, problems with dexterity or force through their hands, or if they’re keen to try it but don’t like the idea of self-touch. They’re also great for people who really want to own their treatment and who get a great response from manual myofascial release with me. The rest of the time with people who are comfortable with self-touch I get them using their own thumbs with one leg up supported or when reclined. For those who aren’t comfortable with self-touch I start with a deep squat...

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